Osteoporosis International

, Volume 24, Issue 1, pp 369–372

Are long-term bisphosphonate users a reality? Dose years for current bisphosphonate users assessed using the danish national prescription database

Short Communication



The prevalence of long-term bisphosphonate use may be low due to low refill compliance and gaps in treatment. An analysis of the prescription history of 58,674 bisphosphonate users in Denmark found that only 2.8 % had received ten dose years of treatment or above.


This study aims to describe the demographics of present bisphosphonate (BP) users, to determine the prevalence of long-term BP use, and to establish if long-term use (a 10-year history of osteoporosis treatment) translated to ten dose years of bisphosphonate prescriptions filled, given the propensity for treatment gaps and low refill compliance with bisphosphonates.


The study population was all persons aged 35 and above, who had filled at least one prescription for an oral bisphosphonate in the year 2008. Past use of osteoporosis medications (bisphosphonates, raloxifene, strontium ranelate, or PTH analogs) for the period January 1, 1995 to December 31, 2007 was retrieved from the Danish National Prescription Database for descriptive analysis.


Of the 58,674 BP users, 46 % were above the age of 75, and 13 % were men. Though 5.9 % had at least a 10-year history of treatment, only half (2.8 %) had received more than ten dose years of a BP. For any osteoporosis drug, 3.0 % had received ten dose years or more, while 23.2 % had received between 5 and 10 years of treatment.


Long-term users with ten dose years or more of a BP are rare due to periods of low compliance and gaps, with a discrepancy between the length of treatment and doses taken. The study also highlights the great number of patients who have used BP for more than five dose years and should be advised on length of treatment, a decision process that will be difficult due to the paucity of long-term safety and efficacy data.


Bisphosphonates Databases Epidemiology Osteoporosis 


  1. 1.
    Shane E, Burr D, Ebeling PR et al (2010) Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 25:2267–2294PubMedCrossRefGoogle Scholar
  2. 2.
    Rizzoli R, Akesson K, Bouxsein M et al (2011) Subtrochanteric fractures after long-term treatment with bisphosphonates: a European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, and International Osteoporosis Foundation Working Group Report. Osteoporosis Int 22:373–390CrossRefGoogle Scholar
  3. 3.
    Schilcher J, Michaëlsson K, Aspenberg P (2011) Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med 364:1728–1737PubMedCrossRefGoogle Scholar
  4. 4.
    Watts NB, Diab DL (2010) Long-term use of bisphosphonates in osteoporosis. J Clin Endocrinol Metab 95(4):1555–1655PubMedCrossRefGoogle Scholar
  5. 5.
    Compston J (2011) Pathophysiology of atypical femoral fractures and osteonecrosis of the jaw. Osteoporosis Int 22:2951–2961CrossRefGoogle Scholar
  6. 6.
    Pazianas M, Abrahamsen B (2011) Safety of bisphosphonates. Bone 49(1):103–110PubMedCrossRefGoogle Scholar
  7. 7.
    Roerholt C, Eiken P, Abrahamsen B (2009) Initiation of anti-osteoporotic therapy in patients with recent fractures: a nationwide analysis of prescription rates and persistence. Osteoporosis Int 20:299–307CrossRefGoogle Scholar
  8. 8.
    Siris ES, Harris ST, Rosen CJ et al (2006) Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc 81:1013–1022PubMedCrossRefGoogle Scholar
  9. 9.
    Kothawala P, Badamgarav E, Ryu S et al (2007) Systematic review and meta-analysis of real-world adherence to drug therapy for osteoporosis. Mayo Clin Proc 82:1493–1501PubMedCrossRefGoogle Scholar
  10. 10.
    Brookhart MA, Avorn J, Katz JN et al (2007) Gaps in treatment among users of osteoporosis medications: the dynamics of noncompliance. Am J Med 120:251–256PubMedCrossRefGoogle Scholar
  11. 11.
    Cramer JA, Silverman SL, Gold DT (2007) Methodological considerations in using claims databases to evaluate persistence with bisphosphonates for osteoporosis. Curr Med Res Opin 23:2369–2377PubMedCrossRefGoogle Scholar
  12. 12.
    Seeman E, Compston J, Adachi J et al (2007) Non-compliance: the Achilles' heel of anti-fracture efficacy. Osteoporosis Int 18:711–719CrossRefGoogle Scholar
  13. 13.
    Compston J (2010) Bisphosphonates and atypical femoral fractures: a time for reflection. Maturitas 65:3–4PubMedCrossRefGoogle Scholar
  14. 14.
    Seeman E (2009) To stop or not to stop, that is the question. Osteoporos Int 20:187–195PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  1. 1.Department of Medicine FGentofte HospitalHellerupDenmark
  2. 2.OPEN, Institute of Clinical ResearchUniversity of Southern DenmarkOdense CDenmark

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